Credit Application

COMPANY LOCATION
Full Legal Company Name:*	/home/texpoly/public_html/credit.php on line 107 " />
Trade Name(s):	/home/texpoly/public_html/credit.php on line 112 " />
Physical Address:*	/home/texpoly/public_html/credit.php on line 117 " />
County:*	/home/texpoly/public_html/credit.php on line 122 " />
City:*	/home/texpoly/public_html/credit.php on line 127 " />
State/Province:*
Postal Code:*	/home/texpoly/public_html/credit.php on line 269 " />
Phone:*	/home/texpoly/public_html/credit.php on line 274 " />
Fax:*	/home/texpoly/public_html/credit.php on line 279 " />
Website:	/home/texpoly/public_html/credit.php on line 284 " />
Billing Address:	Warning: Undefined array key "chkBillingDifferent" in /home/texpoly/public_html/credit.php on line 290 Check here if billing address is different than physical address

Shipping Address:	Warning: Undefined array key "chkBillingDifferent" in /home/texpoly/public_html/credit.php on line 304 Check here if shipping address is different than physical address

CONTACT INFORMATION
Purchasing Contact:*	/home/texpoly/public_html/credit.php on line 320 " />
Email:*	/home/texpoly/public_html/credit.php on line 325 " />
Phone:*	/home/texpoly/public_html/credit.php on line 330 " />
Fax:*	/home/texpoly/public_html/credit.php on line 335 " />
A/P Contact:*	/home/texpoly/public_html/credit.php on line 340 " />
Email:*	/home/texpoly/public_html/credit.php on line 345 " />
Phone:*	/home/texpoly/public_html/credit.php on line 350 " />
Fax:*	/home/texpoly/public_html/credit.php on line 355 " />
COMPANY INFORMATION
Type of Business:*	/home/texpoly/public_html/credit.php on line 363 " />
Year Established:*	/home/texpoly/public_html/credit.php on line 368 " />
FEIN:*	/home/texpoly/public_html/credit.php on line 374 " /> - /home/texpoly/public_html/credit.php on line 376 " />
Is this company Tax Exempt?
Has the company ever filed bankruptcy?
Legal Entity:*
Parent Company:	/home/texpoly/public_html/credit.php on line 424 " />
PRINCIPALS/OFFICERS/KEY MANAGERS
Name:*	/home/texpoly/public_html/credit.php on line 432 " />
Title:*	/home/texpoly/public_html/credit.php on line 437 " />
Phone:*	/home/texpoly/public_html/credit.php on line 442 " />

VOLUME ESTIMATE
Period (Mo./Yr.):*	/home/texpoly/public_html/credit.php on line 458 " />
Product(s):*	<br /> <b>Warning</b>: Undefined array key "txtVolumeProduct" in <b>/home/texpoly/public_html/credit.php</b> on line <b>463</b><br />
Volume/Quantity:*	/home/texpoly/public_html/credit.php on line 468 " />
$ Amount:*	/home/texpoly/public_html/credit.php on line 473 " />
Mytex Polymers Sales Representative:	/home/texpoly/public_html/credit.php on line 478 " />

SIGNATURE
Applicant authorizes investigation of its credit to be used for all Mytex Polymer business purposes. Customer agrees Mytex Polymers Terms and Conditions of Sale shall govern all transactions using Mytex Polymers open account payment credit terms. Applicant agrees to pay all charges in full within the due date of the invoice and is responsible for all collection costs and attorney's fees.
Agreement:*	I have read and agree to the above terms.
Authorized Person's Name:*	/home/texpoly/public_html/credit.php on line 503 " />
Authorized Person's Initials:*	/home/texpoly/public_html/credit.php on line 508 " /> By initialing this form you agree that all information is accurate to the best of your knowledge. Your initials serve as your signature.
Title:*	/home/texpoly/public_html/credit.php on line 514 " />
Email Address for Confirmation:*	/home/texpoly/public_html/credit.php on line 519 " /> An email confirming the submission of this application will be sent to this address.